Guidelines for not resuscitating

Group A - conditions unequivocally associated with death

  • Decapitation
  • Hemicorporectomy (or similar massive injury)
  • Massive cranial and cerebral destruction
  • Decomposition
  • Incineration
  • Rigor mortis
  • Fetal maceration

Group B - conditions requiring ECG (evidence of asystole)

  • Submersion for more than three hours in adults over 18 years of age, with or without hypothermia
  • Continuous asystole, despite CPR, for more than 20 minutes in a normothermic patient
  • Patients who have received no resuscitation for at least 15 minutes after collapse and who have no pulse or respiratory effort on arrival of the ambulance personnel

Timings must be accurate

In all these cases, the ECG record must be free from artefact and demonstrate asystole. There must be no positive history of sedative, hypnotic, anxiolytic, opiate or anaesthetic drugs in the preceding 24 hours.

Group C - terminal illness

  • Cases of terminal illness where the doctor has given clear instructions that the patient is not for resuscitation

Content by Dr Íomhar O' Sullivan 02/03/2004. Reviewed by Dr ÍOS 16/05/2005, 23/05/2006, 27/07/2007. Next review 27/07/2008